Video-Based Evaluation of Checklist Adherence on a Neonatal Intensive Care Unit: A Prospective Observational Study.

Aim: Successful procedural performance in a Neonatal Intensive Care Unit (NICU) depends on skill performance and preparation. Checklists are beneficial, and video reviewing enhances adherence to guidelines. This study assessed whether video recordings can be used to assess checklist deviations, the extent to which proceduralists (doctors from 1 to ≥ 6 years of experience) deviate from checklists, and whether video recordings can help to improve existing and create new checklists.

Methods: In this single-center study at the tertiary NICU of the Medical University of Vienna, Austria, fifty-one videos from six different procedures were analyzed: (i) intubation, (ii) insertion of a chest drain, (iii) insertion of an umbilical venous catheter (UVC), (iv) insertion of a central venous catheter (CVC), (v) lumbar puncture (LP), and (vi) puncture of Ommaya reservoir. Each step was scored using a 4-point scale (-1 to 2) using the corresponding checklist.

Results: Twenty proceduralists performed the 51 videos. 78% of all checklist steps were assessable through video analysis. Deviations were identified in each procedure (10%-17.9%). We created two new checklists by analyzing video recordings.

Conclusion: Checklist deviations occur regularly and can be detected by analyzing clinical video recordings. Video recordings are useful to revise existing and create new checklists.